Surgeons are often faced with stressful situations in the operating room that may negatively affect their performance. Excessive stress has been demonstrated to negatively impact technical and nontechnical performance and increase the likelihood of errors potentially compromising patient safety. Poor ability to deal with stressful situations has also been shown to impede the transfer of simulator--acquired skill to the operating room (OR). Unfortunately, performance--enhancement and stress--coping strategies are not part of surgical training even though they have been shown to be effective at maximizing performance under stressful conditions and are practiced routinely in other disciplines such as the military or for top performing athletes. The goal of this project is to develop a novel, self--contained mental skills curriculum (MSC) that will provide learners with key performance--enhancement and stress--coping strategies needed to achieve superior performance during challenging clinical situations. We hypothesize that the addition of mental skills training to the standard skills curriculum of surgical trainees will minimize performance deterioration under stressful conditions, enhance the skill acquisition and transfer to the clinical arena, and increase retention of simulator--acquired surgical skill. The specific aims of the project are to create an off-the--shelf MSC that can be easily implemented widely, demonstrate its effectiveness in minimizing technical and nontechnical performance deterioration under stressful conditions across levels of learner experience and disciplines, investigate its impact on surgical skill acquisition and retention, identify which learners benefit most from mental skills training, and assess its impact on patient outcomes. To test the hypothesis and achieve the specific aims of this project, a three year multi--specialty study is proposed. During the first year, the MSC will be developed with the help of an expert performance psychologist and pilot tested on a convenience sample of diverse learners to obtain preliminary data and feedback that will allow curriculum optimization. The second year, the effectiveness of the MSC will be tested by randomly assigning novice learners (students) to a control group and a MSC training group and assessing their skill transfer and retention in a live animal OR model after proficiency--based simulator training on the Fundamentals of Laparoscopic Surgery (FLS) modules. The expectation is that the MSC group will achieve higher performance and commit fewer errors than the control group. The third year, general surgery and gynecology residents will also be randomly assigned to a control and a MSC group and train to proficiency on the FLS modules. Their performance will then be compared in the animal OR under regular and stressful conditions and in the human OR, and patient outcomes will be assessed. The expectation is again that the MSC group will outperform the control group in all measured parameters. If the proposed study provides support for its hypothesis, the findings can have a major impact on the way we train learners on simulators, with ultimate benefits for learners, patient safety, and clinical outcomes. In addition, this curriculum will be available as a resource within AHRQ's Patient Safety Network (PSNet) and submitted as a peer reviewed resource within the Association of American Medical Colleges (AAMC) MedEdPORTAL for wide implementation.